Provider Alert! COVID-19 Vaccine Administration Procedure Code M0201 is Now a Benefit

Date: September 20, 2021

Attention: All Providers

Effective Date: Dates of service on or after June 8, 2021

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Effective for dates of service on or after June 8, 2021, COVID-19 vaccine administration add-on procedure code M0201 is now a benefit of Medicaid. Procedure code M0201 is an add-on procedure code for use when a COVID-19 vaccine is administered in the home setting and is the only service provided in the same home on the same date.

Effective for dates of service on or after August 12, 2021, COVID-19 vaccine administration codes 0003A (Pfizer-BioNTech) and 0013A (Moderna) are now benefits for Texas Medicaid. Providers may receive reimbursement for the additional dose of COVID-19 vaccine administered to individuals who are moderately to severely immunocompromised at least 28 days after the second dose of Pfizer-BioNTech or Moderna COVID-19 vaccine. Procedure code 0003A is a benefit for individuals who are 12 years of age and older, and procedure code 0013A is a benefit for individuals who are 18 years of age and older.

How this impacts providers: Procedure code M0201 must be billed with one other COVID-19 vaccine administration code (0001A, 0002A, 0003A, 0011A, 0012A, 0013A, or 0031A). Providers may bill retroactively for COVID-19 vaccine administration add-on procedure code for the home setting provided on or after June 8, 2021.

For vaccine administration codes 0003A and 0013A, providers may bill retroactively for COVID-19 vaccine administration provided on or after August 12, 2021. Affected claims submitted with these procedure codes for dates of service on or after the effective date must be reprocessed.

Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.

Next steps for providers: Providers interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information. Providers should share this communication with their billing staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.